V. W. Longnecker, M. Hartley, F. M. Dingmann, S. Jamieson, J. Kriett, D. Kapelanski
A homozygous sickle cell anemia patient undergoing a pulmonary thromboendarterectomy required the use of profound hypothermia and circulatory arrest. Reports of sickling crises have been documented under conditions of hypoxemia, acidosis, hypothermia, hypovolemia, and blood trauma. This patient's management included preoperative and intraoperative exchange transfusion, increased blood flow rates and optimizing blood gas values to prevent the sickling environment. The pulmonary thromboendarterectomy surgery was successful in reducing pulmonary hypertension in this sickle cell patient. Using these techniques, no adverse sickling effects resulted from the profound hypothermia and circulatory arrest.
{"title":"Cardiopulmonary Bypass in the Sickle Cell Anemia Patient using Profound Hypothermia and Circulatory Arrest: A Case Report","authors":"V. W. Longnecker, M. Hartley, F. M. Dingmann, S. Jamieson, J. Kriett, D. Kapelanski","doi":"10.1051/ject/1998303135","DOIUrl":"https://doi.org/10.1051/ject/1998303135","url":null,"abstract":"A homozygous sickle cell anemia patient undergoing a pulmonary thromboendarterectomy required the use of profound hypothermia and circulatory arrest. Reports of sickling crises have been documented under conditions of hypoxemia, acidosis, hypothermia, hypovolemia, and blood trauma. This patient's management included preoperative and intraoperative exchange transfusion, increased blood flow rates and optimizing blood gas values to prevent the sickling environment.\u0000The pulmonary thromboendarterectomy surgery was successful in reducing pulmonary hypertension in this sickle cell patient. Using these techniques, no adverse sickling effects resulted from the profound hypothermia and circulatory arrest.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1998-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114472765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. L. Pierce, A. Stammers, M. S. Dickes, Kimberly J Taft, D. Beck, C. C. Jones
During cardiac surgery with cardiopulmonary bypass (CPB), fibrinolytic activity may be stimulated when blood exposed to pleural surfaces is suctioned into the extracorporeal circuit (ECC). The purpose of this study was to determine the effect of reinfused blood exposed to pleural surfaces on systemic fibrinolytic activity. Following Institutional Animal Care Utilization Committee approval, 120 ml of blood was drawn from the femoral artery of 4 pigs and placed in both pleural cavities, where it remained for 120 min during CPB. After this time, the exposed blood was suctioned back into the ECC. Blood samples were drawn at the following times: 40 min prior to median sternotomy, 30 and 90 min during CPB, and 30 min post-suction. Tests performed on the samples included thromboelastography (TEG), D-dimer (DD), fibrin degradation products (FDP), fibrinogen concentration, activated clotting time (ACT), hematocrit, and platelet count. TEG index decreased significantly in the circuit following suction (5.28 ± 0.45 vs. 0.98 ± 1.86, p < 0.0007), while fibrinolytic activity increased (6.25 ± 1.50%) in the ECC when compared to pleural blood (2.17 ± 1.04%, p < 0.01). The DD and FDP were both elevated in the systemic circulation following suction of the pleural blood, although statistical significance was not achieved. The ACT was significantly elevated in the pleural fluid during CPB (707 ± 213) compared with the ECC (378 ± 32, p < .003), which may indicate an accelerated consumption of coagulation factors. In conclusion, blood exposed to pleural surfaces may have increased fibrinolytic activity, but systemic hyperfibrinolysis was not seen.
{"title":"Does Hyperfibrinolytic Activity Occur During Cardiopulmonary Bypass from Blood Exposed to Pleural Surfaces?","authors":"M. L. Pierce, A. Stammers, M. S. Dickes, Kimberly J Taft, D. Beck, C. C. Jones","doi":"10.1051/ject/1998303120","DOIUrl":"https://doi.org/10.1051/ject/1998303120","url":null,"abstract":"During cardiac surgery with cardiopulmonary bypass (CPB), fibrinolytic activity may be stimulated when blood exposed to pleural surfaces is suctioned into the extracorporeal circuit (ECC). The purpose of this study was to determine the effect of reinfused blood exposed to pleural surfaces on systemic fibrinolytic activity. Following Institutional Animal Care Utilization Committee approval, 120 ml of blood was drawn from the femoral artery of 4 pigs and placed in both pleural cavities, where it remained for 120 min during CPB. After this time, the exposed blood was suctioned back into the ECC. Blood samples were drawn at the following times: 40 min prior to median sternotomy, 30 and 90 min during CPB, and 30 min post-suction. Tests performed on the samples included thromboelastography (TEG), D-dimer (DD), fibrin degradation products (FDP), fibrinogen concentration, activated clotting time (ACT), hematocrit, and platelet count. TEG index decreased significantly in the circuit following suction (5.28 ± 0.45 vs. 0.98 ± 1.86, p < 0.0007), while fibrinolytic activity increased (6.25 ± 1.50%) in the ECC when compared to pleural blood (2.17 ± 1.04%, p < 0.01). The DD and FDP were both elevated in the systemic circulation following suction of the pleural blood, although statistical significance was not achieved. The ACT was significantly elevated in the pleural fluid during CPB (707 ± 213) compared with the ECC (378 ± 32, p < .003), which may indicate an accelerated consumption of coagulation factors. In conclusion, blood exposed to pleural surfaces may have increased fibrinolytic activity, but systemic hyperfibrinolysis was not seen.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1998-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133298781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Webb, C. P. Altenbern, C. Tritt, F. Downey, D. Minkel
Leukocyte reduction of residual circuit blood following cardiopulmonary bypass (CPB) has been demonstrated to improve lung function and reduce the inflammatory response after surgery. In this study, the effect of lipid/leuko-reduction of salvaged blood on pulmonary function and the inflammatory response was examined. Fifteen patients undergoing elective cardiac surgery were randomly assigned to a lipid/leuko-reduced group or a control group. In addition, all residual circuit blood was transferred to the autotransfusion cell-processing device at the end of CPB to contribute a significant portion of the final washed product. In the lipid/leuko-reduced group (N = 10), all processed blood was passed through a lipid globule, C3a, microaggregate pre-filter, followed by a leukocyte removing filter. In the control group (N = 5), all processed blood was filtered using a 40/150 f.lil1 dual screen transfusion filter. The lipid/leuko-reduced group showed a significant decrease in pulmonary shunt fraction following reinfusion, whereas the control group did not. The lipid/leuko-reduced group also showed a trend towards decreased pulmonary vascular resistance and a blunting of the leukocytosis that develops following the reinfusion of salvaged blood and CPB, although these trends were not statistically significant. There were no statistical differences between the two groups with respect to oxygenation index or circulating red blood cells following reinfusion. These results suggest that lipid/leuko-reducing salvaged blood improves postoperative lung function and is efficacious.
{"title":"Pulmonary Implications of Filtering Various Mediators of Morbidity Found in Salvaged Blood","authors":"D. Webb, C. P. Altenbern, C. Tritt, F. Downey, D. Minkel","doi":"10.1051/ject/1998303108","DOIUrl":"https://doi.org/10.1051/ject/1998303108","url":null,"abstract":"Leukocyte reduction of residual circuit blood following cardiopulmonary bypass (CPB) has been demonstrated to improve lung function and reduce the inflammatory response after surgery. In this study, the effect of lipid/leuko-reduction of salvaged blood on pulmonary function and the inflammatory response was examined. Fifteen patients undergoing elective cardiac surgery were randomly assigned to a lipid/leuko-reduced group or a control group. In addition, all residual circuit blood was transferred to the autotransfusion cell-processing device at the end of CPB to contribute a significant portion of the final washed product. In the lipid/leuko-reduced group (N = 10), all processed blood was passed through a lipid globule, C3a, microaggregate pre-filter, followed by a leukocyte removing filter. In the control group (N = 5), all processed blood was filtered using a 40/150 f.lil1 dual screen transfusion filter. The lipid/leuko-reduced group showed a significant decrease in pulmonary shunt fraction following reinfusion, whereas the control group did not. The lipid/leuko-reduced group also showed a trend towards decreased pulmonary vascular resistance and a blunting of the leukocytosis that develops following the reinfusion of salvaged blood and CPB, although these trends were not statistically significant. There were no statistical differences between the two groups with respect to oxygenation index or circulating red blood cells following reinfusion. These results suggest that lipid/leuko-reducing salvaged blood improves postoperative lung function and is efficacious.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"72 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1998-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124282067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Samuels, M. Kauffman, R. Morris, M. Strong, S. Brockman
We report the successful use of the Abiomed BVS 5000 to provide myocardial support following double valve replacement. Discontinuation of cardiopulmonary bypass (CPB) following aortic and mitral valve replacement was unsuccessful because of severe left ventricular dysfunction and ventricular arrhythmia. Insertion of an intra-aortic balloon pump, initiation of inotropic drugs, and institution of anti-arrhythmic agents were unable to reverse the situation. The Abiomed BVS 5000 ventricular assist device was implanted. The patient was easily weaned from CPB with maximal assist (5.0 L/min) and minimal inotropic (dobutamine 5 mcg/kg/min) support. Orthotopic heart transplantation took place on the fifth postoperative day. The explanted native heart was examined and found to have heavy thrombus deposition on the mechanical valves despite high dose anticoagulation.
{"title":"Successful Bridge to Transplantation with the Abiomed BVS 5000 Ventricular Assist Device Following Double Valve Replacement: A Case Report","authors":"L. Samuels, M. Kauffman, R. Morris, M. Strong, S. Brockman","doi":"10.1051/ject/199830291","DOIUrl":"https://doi.org/10.1051/ject/199830291","url":null,"abstract":"We report the successful use of the Abiomed BVS 5000 to provide myocardial support following double valve replacement. Discontinuation of cardiopulmonary bypass (CPB) following aortic and mitral valve replacement was unsuccessful because of severe left ventricular dysfunction and ventricular arrhythmia. Insertion of an intra-aortic balloon pump, initiation of inotropic drugs, and institution of anti-arrhythmic agents were unable to reverse the situation. The Abiomed BVS 5000 ventricular assist device was implanted. The patient was easily weaned from CPB with maximal assist (5.0 L/min) and minimal inotropic (dobutamine 5 mcg/kg/min) support. Orthotopic heart transplantation took place on the fifth postoperative day. The explanted native heart was examined and found to have heavy thrombus deposition on the mechanical valves despite high dose anticoagulation.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1998-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127512715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Huffman, J. Newberry, L. Fristoe, A. Stammers, M. Grune
Cryosurgery is an emerging treatment method for prostate cancer patients that may expand the scope of practice for perfusionists. Because of the low temperatures needed to cryogenically destroy cancerous tissue, damage to the urethra and bladder may cause incontinence and impotence. As a result of this associated morbidity, an extracorporeal circuit was constructed by the perfusionists at the University of Nebraska Medical Center (Omaha, NE). This urethral perfusion circuit provides a way to maintain normothermic urethral and bladder temperatures during cryogenic procedures, thus preventing trauma to the urethra and bladder. Five patients with a mean age of 73.3 ± 3.0 years diagnosed with localized prostate cancer (Stage A, B, C) were offered cryosurgery using urethral perfusion to treat their cancer. After induction of general anesthesia, a specially designed urethral catheter was inserted. Quarter-inch tubing was attached to barbed connections on the catheter and the free ends were then attached to the circuit. This extracorporeal circuit consisted of a heater/cooler, a twin roller pump, a cardioplegia heat exchanger, and temperature and pressure monitoring devices at the inlet and outlet sites on the catheter. Normal saline was circulated through the tubing of the urethral perfusion circuit to maintain flow rates of 200-400 ml/min, with the circuit pressure not exceeding 300 mmHg. Average urethral perfusion time was 139.3 ± 17.7 minutes. Inlet temperature of the catheter was kept at 42° C to maintain an average bladder temperature of 38.2 ± 2.3° C. All of the patients tolerated the procedure well and were ambulating without assistance on postoperative day one. With the exception of one patient with acute postoperative anuria, patients were discharged on the first postoperative day. Cryosurgery of prostate cancer using urethral perfusion has the potential to serve as a unique practice opportunity for perfusionists.
{"title":"Urethral Perfusion for Cryoablation of the Prostate","authors":"S. Huffman, J. Newberry, L. Fristoe, A. Stammers, M. Grune","doi":"10.1051/ject/19983016","DOIUrl":"https://doi.org/10.1051/ject/19983016","url":null,"abstract":"Cryosurgery is an emerging treatment method for prostate cancer patients that may expand the scope of practice for perfusionists. Because of the low temperatures needed to cryogenically destroy cancerous tissue, damage to the urethra and bladder may cause incontinence and impotence. As a result of this associated morbidity, an extracorporeal circuit was constructed by the perfusionists at the University of Nebraska Medical Center (Omaha, NE). This urethral perfusion circuit provides a way to maintain normothermic urethral and bladder temperatures during cryogenic procedures, thus preventing trauma to the urethra and bladder. Five patients with a mean age of 73.3 ± 3.0 years diagnosed with localized prostate cancer (Stage A, B, C) were offered cryosurgery using urethral perfusion to treat their cancer. After induction of general anesthesia, a specially designed urethral catheter was inserted. Quarter-inch tubing was attached to barbed connections on the catheter and the free ends were then attached to the circuit. This extracorporeal circuit consisted of a heater/cooler, a twin roller pump, a cardioplegia heat exchanger, and temperature and pressure monitoring devices at the inlet and outlet sites on the catheter. Normal saline was circulated through the tubing of the urethral perfusion circuit to maintain flow rates of 200-400 ml/min, with the circuit pressure not exceeding 300 mmHg. Average urethral perfusion time was 139.3 ± 17.7 minutes. Inlet temperature of the catheter was kept at 42° C to maintain an average bladder temperature of 38.2 ± 2.3° C. All of the patients tolerated the procedure well and were ambulating without assistance on postoperative day one. With the exception of one patient with acute postoperative anuria, patients were discharged on the first postoperative day. Cryosurgery of prostate cancer using urethral perfusion has the potential to serve as a unique practice opportunity for perfusionists.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"67 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1998-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121312419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 42 year old male patient presented with chest pain. Cardiac catheterization revealed multivessel coronary disease with a decreased ejection fraction. Following cardiac revascularization, the patient's condition deteriorated and the patient was placed on a Biomedicus left ventricular assist device in the intensive care unit. The following day, an Abiomed BVS 5000 cardiac support system was obtained by the hospital. The patient was brought back to the operating room for implantation of a biventricular pulsatile cardiac assist device and removal of a nonpulsatile left ventricular assist device as a bridge for possible cardiac transplantation. The patient tolerated the procedure well and was transported back to the intensive care unit in stable condition. The patient was accepted for consideration for cardiac transplantation and transported by helicopter to the cardiac transplant center without incident.
{"title":"Conversion to Biventricular Pulsatile Assist as a Bridge to Cardiac Transplantation : A Case Report","authors":"D. Ruby, J. L. Lester","doi":"10.1051/ject/199830135","DOIUrl":"https://doi.org/10.1051/ject/199830135","url":null,"abstract":"A 42 year old male patient presented with chest pain. Cardiac catheterization revealed multivessel coronary disease with a decreased ejection fraction. Following cardiac revascularization, the patient's condition deteriorated and the patient was placed on a Biomedicus left ventricular assist device in the intensive care unit. The following day, an Abiomed BVS 5000 cardiac support system was obtained by the hospital. The patient was brought back to the operating room for implantation of a biventricular pulsatile cardiac assist device and removal of a nonpulsatile left ventricular assist device as a bridge for possible cardiac transplantation. The patient tolerated the procedure well and was transported back to the intensive care unit in stable condition. The patient was accepted for consideration for cardiac transplantation and transported by helicopter to the cardiac transplant center without incident.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1998-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127782227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The purpose of this study was to determine the effect of using polygeline as part of the cardiopulmonary bypass solution in pediatric cardiac surgery. A total of 40 cases were divided into two groups, a polygeline group (H group, n=20) and a plasma group (P group, n=20). Operations were performed under routine extracorporeal circulation. The dose of polygeline or plasma used was calculated to maintain the patient's plasma colloid oncotic pressure at 10-12 mmHg. The results showed that in the polygeline group, no patient developed allergic or coagulation disorders even after large volumes of polygeline were used (45 ml/kg). At the initiation and completion of cardiopulmonary bypass (CPB), the concentrations of calcium were higher in the H group (1.38 ± 0.19, 1.21 ± 0.11) than those (0.72 ± 0.11, 0.95 ± 0.10) in the P group. There were no other statistically significant differences between the two groups. There were no organ problems in the patients included in the study. This study demonstrated that polygeline could be used as part of prime solution instead of plasma to keep an ideal plasma colloid oncotic pressure, reduce infections caused by blood product transfusions and lower the cost to the patients.
{"title":"Application of Polygeline in Pediatric Cardiac Surgery","authors":"De-ming Zhu, Hong Chen, Wei Wang, Ying Chen","doi":"10.1051/ject/199830120","DOIUrl":"https://doi.org/10.1051/ject/199830120","url":null,"abstract":"The purpose of this study was to determine the effect of using polygeline as part of the cardiopulmonary bypass solution in pediatric cardiac surgery.\u0000A total of 40 cases were divided into two groups, a polygeline group (H group, n=20) and a plasma group (P group, n=20). Operations were performed under routine extracorporeal circulation. The dose of polygeline or plasma used was calculated to maintain the patient's plasma colloid oncotic pressure at 10-12 mmHg.\u0000The results showed that in the polygeline group, no patient developed allergic or coagulation disorders even after large volumes of polygeline were used (45 ml/kg). At the initiation and completion of cardiopulmonary bypass (CPB), the concentrations of calcium were higher in the H group (1.38 ± 0.19, 1.21 ± 0.11) than those (0.72 ± 0.11, 0.95 ± 0.10) in the P group. There were no other statistically significant differences between the two groups. There were no organ problems in the patients included in the study.\u0000This study demonstrated that polygeline could be used as part of prime solution instead of plasma to keep an ideal plasma colloid oncotic pressure, reduce infections caused by blood product transfusions and lower the cost to the patients.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1998-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132486791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Phillipp, R. Behr, MOt M. Rengr, Moo D M. Kaiser, Mdo Birnbaum, Abt. Kardiotechnik
Extracorporeallung assist (ECLA) is an established form of treatment for acute pulmonary insufficiency. Classically, it takes the form of veno-venous bypass. The femoral vein and the subclavian vein are favored cannulation sites. Blood is pumped with either a roller or a centrifugal pump. Sometimes heparin-coated cannulae, membrane oxygenators (MO), and tubing are used, which may significantly reduce the risk of bleeding. A device pumping 1.0 to 4.0 liters per minute nevertheless signifies a persistent mechanical stress for the cellular blood components and causes some degree of hemolysis. A 42 year old patient with acute pancreatitis and marginal clotting parameters developed profound pulmonary insufficiency. All modes of mechanical ventilation were exhausted and proved to be inadequate. Under good hemodynamic conditions, an arterio-venous pumpless ECLA was instituted for a duration of 10 days, when the patient could be successfully weaned. The membrane oxygenator was connected via cannulae in the femoral artery and femoral vein.
{"title":"Pumpless Extracorporeal Lung Assist","authors":"A. Phillipp, R. Behr, MOt M. Rengr, Moo D M. Kaiser, Mdo Birnbaum, Abt. Kardiotechnik","doi":"10.1051/ject/199830138","DOIUrl":"https://doi.org/10.1051/ject/199830138","url":null,"abstract":"Extracorporeallung assist (ECLA) is an established form of treatment for acute pulmonary insufficiency. Classically, it takes the form of veno-venous bypass. The femoral vein and the subclavian vein are favored cannulation sites. Blood is pumped with either a roller or a centrifugal pump. Sometimes heparin-coated cannulae, membrane oxygenators (MO), and tubing are used, which may significantly reduce the risk of bleeding. A device pumping 1.0 to 4.0 liters per minute nevertheless signifies a persistent mechanical stress for the cellular blood components and causes some degree of hemolysis.\u0000A 42 year old patient with acute pancreatitis and marginal clotting parameters developed profound pulmonary insufficiency. All modes of mechanical ventilation were exhausted and proved to be inadequate. Under good hemodynamic conditions, an arterio-venous pumpless ECLA was instituted for a duration of 10 days, when the patient could be successfully weaned. The membrane oxygenator was connected via cannulae in the femoral artery and femoral vein.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1998-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122748318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PhD M.L. Zucker, MS C.L. Barrett, BA K. Bennett, PhD F.M. LaDuca
Methods used to maintain a hemostatic balance during cardiopulmonary bypass surgery include the optimization of heparin and protamine dosing. Higher heparin doses have been associated with increased bleeding, while other studies have attributed reduced blood loss and transfusion requirements to lower protamine doses. We have evaluated the use of an in vitro heparin and protamine titration system and compared it to standard dosing in patients undergoing surgery requiring cardiopulmonary bypass. Based upon the principle of the Hemochron® RxDx® system, Heparin Response Tests (HRT) and Protamine Response Tests (PRT) were performed for 40 patients undergoing cardiac surgery at three hospital centers. The Activated Clotting Time (ACT) was used to monitor adequate heparin dosing prior to placing the patient on bypass, and to monitor heparin reversal after protamine dosing. The efficacy of heparin reversal was determined using the Protamine Dose Assay (PDA-O) test. All centers used standard hospital pharmaceutical preparations of heparin and protamine. Heparin and protamine RxDx dosing was compared to standard hospital practice for each site. Based on the HRT, the average heparin dose was not different from empirical dosing; however, individual differences were as high as 11,000 units. Only a single patient required a second heparin bolus prior to initiation of bypass. On average, the protamine dose predicted by the PRT was only 67% of the empirical protamine dose. The PDA-O test identified the need for additional protamine in 13% of patients. Patients administered additional protamine at the request of the surgical team, despite the presence of a normal PDA-O test, had no further decrease in ACT. In summary, the in vitro HRT and PRT system did not alter the initial heparin dose yet significantly decreased the protamine doses administered. Based on prior clinical outcome studies, this reduction is expected to have a beneficial effect on postoperative bleeding and transfusion requirements.
{"title":"Utility of In Vitro Heparin and Protamine Titration for Dosing During Cardiopulmonary Bypass Surgery","authors":"PhD M.L. Zucker, MS C.L. Barrett, BA K. Bennett, PhD F.M. LaDuca","doi":"10.1051/ject/1997294176","DOIUrl":"https://doi.org/10.1051/ject/1997294176","url":null,"abstract":"Methods used to maintain a hemostatic balance during cardiopulmonary bypass surgery include the optimization of heparin and protamine dosing. Higher heparin doses have been associated with increased bleeding, while other studies have attributed reduced blood loss and transfusion requirements to lower protamine doses. We have evaluated the use of an in vitro heparin and protamine titration system and compared it to standard dosing in patients undergoing surgery requiring cardiopulmonary bypass. Based upon the principle of the Hemochron® RxDx® system, Heparin Response Tests (HRT) and Protamine Response Tests (PRT) were performed for 40 patients undergoing cardiac surgery at three hospital centers. The Activated Clotting Time (ACT) was used to monitor adequate heparin dosing prior to placing the patient on bypass, and to monitor heparin reversal after protamine dosing. The efficacy of heparin reversal was determined using the Protamine Dose Assay (PDA-O) test. All centers used standard hospital pharmaceutical preparations of heparin and protamine.\u0000Heparin and protamine RxDx dosing was compared to standard hospital practice for each site. Based on the HRT, the average heparin dose was not different from empirical dosing; however, individual differences were as high as 11,000 units. Only a single patient required a second heparin bolus prior to initiation of bypass. On average, the protamine dose predicted by the PRT was only 67% of the empirical protamine dose. The PDA-O test identified the need for additional protamine in 13% of patients. Patients administered additional protamine at the request of the surgical team, despite the presence of a normal PDA-O test, had no further decrease in ACT.\u0000In summary, the in vitro HRT and PRT system did not alter the initial heparin dose yet significantly decreased the protamine doses administered. Based on prior clinical outcome studies, this reduction is expected to have a beneficial effect on postoperative bleeding and transfusion requirements.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1997-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131628483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The Abiomed Bi-Ventricular Support System is recommended for patients with post-cardiotomy ventricular dysfunction who have undergone successful cardiac surgery, and then subsequently develop low cardiac output, impairing hemodynamic stability. Stagnant blood flow from ventricular unloading increases the potential for thrombus formation on artificial surfaces of ventricular assist devices and mechanical valves. This case discusses the management of a patient successfully weaned from Abiomed bi-ventricular support following coronary artery bypass and mitral valve replacement with a mechanical prosthesis. We will also describe the management of a console failure that occurred before device explantation.
{"title":"Successful Bi-Ventricular Abiomed Support in a Coronary Artery Bypass/Mitral Valve Replacement Patient","authors":"K. D. Swoyer, M. Martin, R. Illes","doi":"10.1051/ject/1997294197","DOIUrl":"https://doi.org/10.1051/ject/1997294197","url":null,"abstract":"The Abiomed Bi-Ventricular Support System is recommended for patients with post-cardiotomy ventricular dysfunction who have undergone successful cardiac surgery, and then subsequently develop low cardiac output, impairing hemodynamic stability. Stagnant blood flow from ventricular unloading increases the potential for thrombus formation on artificial surfaces of ventricular assist devices and mechanical valves. This case discusses the management of a patient successfully weaned from Abiomed bi-ventricular support following coronary artery bypass and mitral valve replacement with a mechanical prosthesis. We will also describe the management of a console failure that occurred before device explantation.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1997-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124147911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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